1. Negative Health Effects of Secondhand Smoking: Heart Disease Eric L. Johnson, M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota School of Medicine and Health Sciences Assistant Medical Director Altru Diabetes Center

3. Smoking Causes Death Smoking causes approximately 90% of all lung cancer deaths in men 80% of all lung cancer deaths in women 90% of deaths from chronic obstructive lung disease (COPD) CDC

4. Smoking Causes Death Compared with nonsmokers smoking increases risk of— Coronary heart disease by 2 to 4 times Stroke by 2 to 4 times Men developing lung cancer by 23 times Women developing lung cancer by 13 times Dying from chronic obstructive lung diseases (COPD) by 12 to 13 times CDC

5. Tobacco Use in North Dakota ~116,000 ND adults and ~8,000* HS students smoke cigarettes ~20,000 ND adults and ~3,800^ HS students use spit tobacco -HS students: *26% in 2003, 27% in 2005, 22% in 2007 ^10% in 2003, 12.7% in 2005, 10.2% in 2007 (BRFSS 2008) (YRBS 2005,2007)

6. However, today our focus on not on negative health effects on the smoker…..

7. Secondhand Smoke (Passive Smoking) Negative effects of smoke on people who aren’t doing the smoking No longer speculation that this is dangerous for those exposed to secondhand smoke

8. Secondhand Smoke Deaths United States Lung cancer – 3,000 deaths annually Heart Disease – 35,000 deaths annually North Dakota 80-140 deaths annually CDC American Cancer Society

9. Second Hand Smoke and Cardiovascular Risk (Heart Attack) Cardiovascular Risk (Heart Attack) is ~80-90% of primary smoking Secondhand smoke increases risk of heart attack by 30% Well understood phenomenon- no longer speculative concerning harmful effects Barnoya A, Glantz S Circulation May 24 2005 The Health Consequences of Involuntary Exposure to Tobacco Smoke: Report of the Surgeon General 2006

10. “Smoking Ban” “Smoking Ban” is not an adequate description More descriptive…. “Comprehensive Smoke Free” legislation “Smoke Free” Policy

11. Smoke Free Legislation Typically, legislation that eliminates smoking in public places The smoker is NOT the medical focus of this type of legislation (not protecting the smoker from themselves) Focus in on reducing injury inflicted on others

12. Smoke Free Legislation and Heart Attack LocationPopulation Change in Heart Attack Hospital Admissions Helena 68,140 −40% Pueblo 698,229 (2counties) −41% New York 18,976,457 −8% Indiana 239,332 −50% Ohio 29,636 −20% Saskatoon 202,340 −13%

13. Communities Similar to Grand Forks Pueblo, CO Population 103,648 College Town Decrease in Heart Attacks following “smoking ban” 27%

14. Communities Similar to Grand Forks Bowling Green, OH Population 29,636 College Town Reduction in Heart Attacks following “smoking ban” 19%

15. Communities Similar to Grand Forks Helena, MT Population 47,154 College Town Reduction in Heart Attack with “smoking free” legislation 40% Increase in Heart Attacks following smoke free legislation repeal 40%

16. “Smoke Free Legislation” and Heart Attack 11 legitimate studies Europe, U.S., Canada Approx 17% reduction in Heart Attack across all studies Approx 195,000 Heart Attacks would be avoided in U.S. annually In an age of health care cost containment, can’t disregard